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04.06.2014, admin
Plantar fasciitis is most often seen in middle-aged men and women, but can be found in all age groups. There are also other less common problems such as nerve entrapments, stress fractures, and fat pad necrosis, all of which can cause foot pain. Plantar fasciitis occurs because of irritation to the thick ligamentous connective tissue that runs from the heel bone to the ball of the foot. When a patient has plantar fasciitis, the connective tissue that forms the arch of the foot becomes inflamed (tendonitis) and degenerative (tendinosis)–these abnormalities cause plantar fasciitis and can make normal activities quite painful. To prevent the recurrence of plantar fasciitis after treatment, proper fitting footwear is essential. In a small number of cases (usually less than 5%), patients may not experience relief after trying the recommendations listed above.
As stated above, simple treatment measures will usually work in the treatment of plantar fasciitis. Surgery should be reserved for patients who have made every effort to fully participate in conservative treatments, but continue to have pain from plantar fasciitis.
If you fit these criteria, then surgery may be an option in the treatment of your plantar fasciitis. When your surgeon releases the plantar fascia, it is important to only release about 30-50% of the fascia. As stated earlier in this article, pain around the heel of the foot may not always be due to plantar fasciitis. Symptoms of plantar fasciitis may closely resemble symptoms of other foot problems. New surgical techniques allow surgery to release the plantar fascia to be performed through small incisions using a tiny camera to locate and cut the plantar fascia.
Our Podiatrists are trained and certified foot and ankle physicians that treat all foot disorders. Our physicians are trained surgeons skilled in the correction of all foot abnormalities such as bunions, hammertoes, heel pain and neuromas.
Our physicians spend quality time with our patients in order to diagnose each foot disorder. Plantar fasciitis is diagnosed with the classic symptoms of pain well localized over the heel area of the bottom of the foot. In tarsal tunnel syndrome, an important nerve in the foot, the tibial nerve, is trapped and pinched as it passes through the tarsal tunnel, a condition analogous to carpal tunnel syndrome in the wrist.


This treatment, called extracorporeal shock wave therapy, or ESWT, uses energy pulses to induce microtrauma to the tissue of the plantar fascia. It is important that conservative treatments (such as those listed above) be performed for AT LEAST a year before considering surgery. The vast majority of patients diagnosed with plantar fasciitis will recover given ample time.
These treatments include anti-inflammatory medication, shoe inserts, and stretching exercises. What I mean by this, is surgeons can reliably predict that patients with severe knee arthritis will do well after knee replacement surgery about 95% of the time. Release of more of the plantar fascia during surgery may cause a flat foot deformity due to the loss of the arch of the foot. These nerves, even with protection, may be damaged during surgery to release of the plantar fascia. If a patient sustains an infection following surgery, they will require antibiotics and may require further surgery to remove any infection. Whether you are suffering from pain, discomfort or an embarrassing condition, we can help you. The doctors, along with our team of nurses and office personnel, strive to achieve the highest quality level of personalized, comprehensive foot care. About 70% of patients with plantar fasciitis have been noted to have a heel spur that can be seen on X-Ray.
Often the pain from plantar fasciitis is most severe when you first stand on your feet in the morning. In these athletes, it is thought that the repetitive nature of the sports causes the damage to the fibrous tissue that forms the arch of the foot. These syndromes such as Reiter’s syndrome and ankylosing spondylitis can cause heel pain similar to plantar fasciitis. As you begin to loosen the foot, the pain usually subsides, but often returns with prolonged standing or walking. Custom orthotics can also be made if there appears to be a problem with the mechanical structure of the foot. Time is very important in curing the pain of plantar fasciitis, and insufficient treatment before surgery may subject you to potential complications of the procedure.


With some basic treatment steps, well over 90% of patients will achieve full recovery from symptoms of plantar fasciitis within one year of the onset of treatment. In cases where a good effort with these treatments fails to provide adequate relief, some more aggressive treatments may be attempted. Flat foot after surgery can lead to chronic problems that may be as bad as the plantar fasciitis. Because of this, a small percentage of patients may have pain or numbness in areas of the foot following plantar fasciitis surgery. While there are potential complications, about 70-80% of patients will find relief after plantar fascia release surgery.
Some surgeons are concerned that the endoscopic plantar fascia release procedure increases the risk of damage to the small nerves of the foot.
If your symptoms are not typical for plantar fasciitis, or if your symptoms do not resolve with treatment, your doctor will consider these possible diagnoses. ESWT is recommended in patients who have failed the previously mentioned treatments, and are considering surgical options. If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release.Because the diagnosis of plantar fasciitis can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel release) along with the plantar fascia release. This may not be perfect, but if plantar fasciitis has been slowing you down for a year or more, it may well be worth these potential risks of surgery.
While there is no definitive answer that this endoscopic plantar fascia release is better or worse than a traditional plantar fascia release, most surgeons still prefer the traditional approach. These simple exercises will help maintain the flexibility of the foot and prevent the plantar fasciitis pain from returning. This surgery is about 80% successful in relieving pain in the small group of patients who do not improve with conservative treatments.



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